OG9.1 | Abortion Syndromes — Summary & Reflection

KEY TAKEAWAYS

Abortion is defined as expulsion of the products of conception before 20 weeks or when the fetus weighs <500 g. The six clinical types are: threatened (closed os, viable fetus), inevitable (open os, no tissue passed), incomplete (partial expulsion, open os), complete (all tissue passed, os closed), missed (dead fetus retained, os closed), and septic (any type + infection). The most common cause of first-trimester spontaneous abortion is chromosomal aneuploidy (~50–60%). Investigations include USG (central), serial β-hCG (viability and ectopic exclusion), blood group/Rh (anti-D mandate for Rh-negative women), and blood cultures/HVS in septic cases. Management is type-specific: threatened abortion — expectant ± progesterone; incomplete/inevitable — MVA preferred over sharp curettage; missed — expectant/medical (mifepristone + misoprostol)/surgical; septic — IV antibiotics FIRST, then evacuation, escalate to ICU if shock. The MTP Act 2021 allows termination up to 20 weeks with one RMP's opinion, 20–24 weeks with two RMPs for specified categories, and beyond 24 weeks only via State Medical Board for substantial fetal abnormality. PCPNDT 1994 prohibits sex determination.

REFLECT

A woman comes to your casualty at 11 weeks with an open cervical os and heavy bleeding. She is haemodynamically stable but distressed. Consider: How does naming the correct type of abortion (inevitable, incomplete, complete, septic) change the immediate management decision? At what point in the clinical examination did you make your diagnosis — history, vital signs, or pelvic findings? What would you say to this woman and her family in the next 5 minutes while you prepare for evacuation? Reflect on how your understanding of the molecular mechanisms of trophoblast failure connects to the clinical signs you see at the bedside.